How can you relieve insomnia?(2)

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Insomnia is a fairly common condition. About 10 percent to 15
percent of adults in the U.S. say they have persistent problems
falling or staying asleep, and getting a good night’s rest. And a
third to half of adults say they have at least one episode of
insomnia per year. Insomnia can strike people of any age, including
children. But older people are more likely to have trouble
sleeping.

Insomnia is not a disease. Doctors and sleep experts define
three levels of insomnia: (1) transient, (2) intermittent
short-term, and (3) chronic. Most people have had transient
insomnia at some point in their lives. It can be caused by any
number of things. Intermittent and chronic insomnia can be more
serious and deserve the attention of your doctor. Insomnia can have
serious health affects.

However, there is concern that the newer sleeping pills are
over-prescribed and inappropriately prescribed. For several years
they have been heavily advertised both to doctors and consumers,
which may have led to excessive use. At the same time, studies
show that chronic insomnia is under-treated, with fewer than half
of the people who need help getting it.

Not all cases of insomnia require treatment, but if you and
your doctor decide it is the best course of action for you, there
four drugs used to treat insomnia – zolpidem (Ambien and Ambien
CR), eszopiclone (Lunesta), ramelteon (Rozerem), and zaleplon
(Sonata) – have been widely promoted to both doctors and consumers.

According to a recent
Consumer Reports Best Buy Drugs report on drugs to treat
insomnia, while effective, these medicines are not necessarily
better than older, less expensive drugs for many people who need a
sleep aid for a night or two. For example, nonprescription drugs
containing antihistamines (Benadryl, Nytol, Tylenol PM, and
Sominex) and older prescription sedatives called benzodiazepines
may work just as well. Among the benzodiazepines approved as sleep
aids are estazolam (ProSom), flurazepam (Dalmane), and temazepam
(Restoril).

However, we recommend that both the older and newer sleeping
pills be taken more judiciously and less often than appears to be
the current pattern of use by millions of people in the U.S. There
are two main reasons for that advice:

• People with only mild insomnia problems may be relying too
heavily on pills and not trying to address their sleep problems
with non-drug measures.

• All insomnia medicines have side effects, can cause
dependency, and even worsen your sleeping problems when abused,
misused, or taken too often. The possible side effects include
daytime sleepiness, cognitive impairment, dizziness, unsteadiness,
and rebound insomnia. Sleep-walking, sleep-driving, memory lapses,
and hallucinations have also been reported.

People with persistent, chronic insomnia – three or more
nights a week for months on end – do need treatment. We advise
behavioral therapy that improves sleep habits, possibly combined
with cautious use of sleeping pills. You should also know that many
prescription and nonprescription drugs – such as steroids, certain
pain relievers, caffeine pills, and decongestants – can also
trigger insomnia.

For the average person seeking short-term help – for a few
nights – we suggest trying an over-the-counter sleep aid first. If
that doesn’t work, our comparison of the newer drugs led us to
choose zolpidem as a Best Buy. This is the less expensive generic
version of the drug Ambien. Fifteen pills cost $10 to $35,
depending on dose and where you buy it.

Finally, there is one non-drug treatment alternative that has
proven quite effective in treating insomnia. It’s called cognitive
behavioral therapy, or CBT. Behavioral therapy involves getting
help from a therapist (one trained in CBT) to learn a new set of
behaviors around sleep. Studies have found that behavioral therapy
is effective--helping 70 percent to 80 percent of people with
chronic insomnia--and several studies have found that it works
better than sleeping pills alone. In other studies, a combination
of the two has helped most.